Tennessee’s Own: LIFESTAR Air Medical Services â€Šâ€Š

The University of Tennessee’s LIFESTAR air medical
transport program operates a pair of EC135s, such as the
one shown here, and two Bell 407s. They serve Eastern
Tennessee and portions of Virginia, Georgia, and
the Carolinas.

Imagine enjoying a nice drive through Tennessee’s Great Smoky Mountains National Park. The lush, green trees and Azure blue skies are all around you. But then, you see a flash of color followed by darkness and a strange sort of sleep. The next thing you’re aware of is searing pain, loud noises and someone telling you that you will be all right.

You see, thirty minutes earlier you had been in a head-on automobile collision. Your injuries are so severe, you only have another 30 minutes to reach a level-one trauma center before your chances of survival become significantly thinner. And that voice telling you that you will be okay? That’s a flight nurse aboard the helicopter that’s taking you on a 12-minute flight to a trauma center that would have taken 40 minutes to reach by ambulance.

While this scenario is one that most of us will never have to experience, it’s how many people end up meeting the men and women who crew the helicopters of the University of Tennessee Medical Center’s (UTMC) LIFESTAR program.

LIFESTAR Air Medical Services, the official name of UTMC’s the air transport operation, invited Rotor & Wing to visit its base in Knoxville.

As tends to be my luck with the weather, it was dark, rainy and overcast when I arrived at LIFESTAR’s hangar, which sits on the same massive campus as UTMC. Above the door was a sign that read “Robert F. Lash, M.D. Aeromedical Center.”

Inside, several people greeted me, including Jeff Gregory, LIFESTAR’s program director, His office was filled with models of the operation’s various aircraft, both past and present. A large scrapbook on his conference table chronicled the details of the program’s birth by way of brittle newspaper clippings and yellowing photographs.

It was back in the early 1980s when the late Dr. Robert Lash, a UTMC faculty member and the physician the hangar is named after, pushed for the creation of a full-time air medical transport program for the hospital system. He understood that the remoteness of many parts of eastern Tennessee could make getting seriously ill and injured citizens to a trauma center by ground transportation too lengthy. He wanted to find a way to cut a trip to the hospital down to no more than one hour.

The core of that belief was based upon the “Golden Hour” principle, which says that a person’s chances of survival plummet if they do not reach a medical facility within 60 minutes.

Although civilian air medical transports had been in operation in other parts of the country since 1970, Lash still had to prove the concept in the Knoxville area. He did so by employing the Tennessee State Highway Patrol’s Huey from time to time, often arriving on the scene himself to lend medical assistance.

The value of airlifting patients to a hospital was quickly seen, and funding for UTMC’s own twin-engine Bell 222 was allocated. Dr. Lash, of course, was the best choice to run and grow the unit.

“We took delivery of our first aircraft in late August of 1984,” said Gregory, who joined the program as a flight medic just two years after that. “Unfortunately, we got off to a rocky start.”

By “rocky start,” Gregory was referring the day LIFESTAR made its public debut. Because on that day, after a big media event and photo opportunity, Dr. Lash and crew departed on a flight to look at possible landing zones on the campus. While checking out one of them, the aircraft crashed. The good news is that there were no injuries.

LIFESTAR flew its first patient on Oct. 1, 1984, in a Bell 206L4. The three-person crew then – as is the case today – consisted of a pilot, a flight nurse, and a paramedic. In fact, two of the original members, paramedic Tim King and registered nurse Kay Kirkland, are still with the program. (King works in the dispatch center, and Kirkland still flies crew.)

LIFESTAR’s EC135s are equipped with the Zoll
M-Series monitor/defibrillators, either the MedSystem
III or SIGMA Spectrum infusion system, and Pnuepac
ParaPAC ventilator. Each crewmember is also issued
a set of NVGs for night missions.

Over the years, the operation has flown the Bell 222, 430 and 412, all of which were owned by UTMC, and outfitted for medevac mission by Wysong Enterprises in Blountville, Tenn. But in 2007, LIFESTAR contracted Dallas-based Med-Trans to provide the helicopters, pilots and maintainers, which changed the operation’s aircraft mix to its current fleet of two EC135s and a pair of Bell 407s. (A third Bell 407 is available as a backup if any of the other aircraft have to be removed from service for any length of time.) Wysong outfitted the 407s, while the EC135s received completions through Metro Aviation of Shreveport, La.

For the record, LIFESTAR did operate a twin-engine Piper Navajo airplane for several years, but sold it off after reevaluating its worth to the operation.

LIFESTAR’s service area was quite large upon its inception, primarily because it was one of only two air transport operations in the region. (Vanderbuilt University was the other.) As more hospital systems acquired air assets, LIFESTAR’s primary area of responsibility morphed into its current shape.

“We were pretty much serving a 150-nm radius when we started out,” explained Gregory. “Now, we’re down to about a 21-county area that surrounds Knoxville. So, most of our flights are within about an 80-nm radius.” (That encompasses eastern Tennessee, the northernmost part of Georgia, and western portions of Virginia and the Carolinas.)

Gregory didn’t have to mention the high elevations that LIFESTAR aircraft must be powerful enough to negotiate. I saw the 6,000-foot peaks that rose from the mountain ranges during my trip in!

LIFESTAR’s headquarters is a 3,800-square-foot combination of office and hangar on the east side of UTMC in Knoxville. It houses the operation’s administrative offices, the 24-hour dispatch center, a fuel site, and a hangar suitable for light maintenance. Its back-up Bell 407 often is kept there, too.

EC135 over a parking lot in Knoxville.

Missions, however, are primarily flown out of the bases in Andersonville, Morristown, Sevierville and Sweetwater, located 18 miles north, 41 miles northeast, 22 miles west and 37 miles southwest, respectively. Each location primarily feeds patients into Knoxville, but LIFESTAR crews will take patients to any other suitable hospital if UTMC has reached capacity.

Since UTMC is the hub that most flights bring patients into, a GPS approach procedure was certified by the FAA to help get pilots in on days – like the one when I was there – when the clouds and fog hang near the hospital’s pad for the better part of the day.

Gregory reported that of the approximately 2,000 patients that LIFESTAR transports per year, about half of them are picked up from incident scenes, while the other half are inter-facility transfers. He also said that between 65 and 75 percent of all flights involve patients who need immediate trauma care.

“We do neonatal flights,” said Gregory, a certified paramedic himself. “But in the sense that all we are doing is flying a [neonatal specialty team] out, and not the [incubators]. We’re not actually flying babies back on the aircraft right now, but we’re probably going to start doing that soon.”

Caring for the patients are 19 flight nurses and 30 paramedics employed by UTMC, some of whom only work part-time aboard LIFESTAR’s helicopters. (Their full-time duties lie elsewhere in the hospital.) Each flight carries one of each.

“The reason we have more paramedics is because our communications center is staffed with paramedics,” explained Gregory.

Med-Trans provides the pilots for the helicopters, with experience running the gamut from civilian-raised pilots to former military gunship drivers. But in order to apply, a potential pilot must have at least a commercial rotorcraft license with an instrument rating, a minimum of 2,000 hours helicopter time, and 1,000 hours of pilot-in-command time in helicopters, including at least 200 hours of instrument time. Once hired, pilots are assigned to just one platform, either the Bell 407 or the EC135.

Flight crews work a combination of shifts. The Morristown and Sweetwater hangars, where the EC135s are primarily based, work a 24-hour shift that begins at 7:00 am. They work one day, and are then off for two. At Andersonville and Sevierville, where the Bell 407s nest, crews work a 12-hour shift that begins either at 7:00 am or 7:00 pm. They work five days on, followed by five days off, then two days on, followed by two days off.

It is said that there is just one weather pattern in Tennessee, and that’s no pattern at all. Consequently, Med-Trans only selects pilots with strong instrument skills, and prefers pilots who hold ATP-rotorcraft licenses. And even then, they are subjected a grueling check ride every 90 days that includes a variety of IFR scenarios, with a few systems failures thrown in just for good measure. Proficiency with double IMC recoveries is a major focus, as well.

Jeff Gregory (left) and Fred Buttrell on the tarmac with UT helicopters.

During a pilot’s 90-day recurrent training evolution, the paramedic and the flight nurse go along, but not to kill time. They are pulled into many of the scenarios so that all may practice crew coordination. Medical personnel are not, however, taught to “pinch hit” for the pilot. In fact, LIFESTAR aircraft only have flight controls on the pilot’s side of the ship, except when a safety pilot is aboard for training purposes.

Med-Trans provides maintenance, assigning one mechanic to each aircraft base, plus one additional person who bounces between the bases when extra help is needed, or to fill in for a vacationing comrade. Typically, they will do a daily inspection on the aircraft in the morning, perform scheduled maintenance as required, and conduct fuel site inspections. And, of course, they are on call for those pesky warning lights that only come on at 3 o’clock in the morning when it’s below freezing outside.

As we concluded our talk in Gregory’s office, we walked into the communications center, where incoming calls for the helicopter are received, prioritized, and assigned to the crews. It was also there that I met Tim King and Jason Seiber, the on-duty dispatchers. Seiber had a little less than eight years at LIFESTAR, while King – the person whom Gregory had said was an original member – was nearing 30 years with UTMC. For flight following and communications purposes, LIFESTAR ships, as well as other medevac aircraft in that part of the state, are equipped with SkyTrac, a satellite-based system that plots the location of participating aircraft. It also provides the crew with voice and text messaging technology.

King and Seiber were each seated in front of their own set of colorful SkyTrac monitors that told them where every air medical asset in the region was. If the helicopter was at its base, the box next to its icon showed its tail number, call sign and location on a map. If it was in the air, the box showed the same information, plus the aircraft’s altitude, speed and track. A bank of phones lines and a radio suite completed setup.

My next stop was to the apron, where I got a close look at one each of LIFESTAR’s Eurocopter EC135 P2+s and Bell 407s. Each was in great shape, and proudly wore the official colors of the University of Tennessee: orange, white and black.

Mounted on both aircraft is a Spectrolab SX-5 Starburst searchlight, a pair cable cutters, and a set of high skids.

The front office of each aircraft is equipped with NVG-compatible instruments, Technisonic RC-6000 radio suites, Garmin 430/530 GPS and GTX 330 transponder gear, and XM Satellite weather mapping. To enhance safety and reduce pilot workload, both aircraft are equipped with TCAS, and the EC-135 has an autopilot. All crewmembers are issued a set of ITT 4949 level 9 night vision goggles.

The aft cabin contains everything an in-flight care provider needs. Bell 407 crewmembers have the Zoll E-Series monitor/defibrillator, while EC135 personnel have the M-Series. They use the MedSystem III and SIGMA Spectrum infusion systems, and Pnuepac ParaPAC ventilator.

Refrigerated blood banks are maintained at each hangar, allowing each crew to carry two units of whole blood with them when they launch.

Before leaving, I had to walk the length of LIFESTAR’s facility to retrieve my gear. As I looked around I noticed something was missing.

There was no memorial or recognition plaque for crewmembers who had lost their lives while flying a mission. And the reason is because three decades and 50,000 missions after the late Dr. Lash’s great idea, no UT LIFESTAR member has died or even been injured while doing their job. I think the doctor would have liked that.

A Visit With Med-Trans President & CEO Fred Buttrell

Fred Buttrell is the person in charge of Med-Trans, a national provider of air medical transportation services based in Dallas, Texas. His company’s business model is to provide “customized air ambulance programs through alternative delivery/shared resource models, community-based models, or traditional hospital-based models.”

Buttrell happened to be at the University of Tennessee’s LIFESTAR headquarters in Knoxville while Rotor & Wing was visiting the facility, and agreed to talk about his company’s six-year relationship with the program.

“Our business strategy is to partner with health systems that have a unique footprint, and tailor-make an air solution for them,” explained Buttrell, who took over Med-Trans in 2006 after a career as a fighter pilot in the U.S. Air Force.

“Air medicine is a team sport. You’ve got a lot of constituencies that have to work together, so we put in a lot of energy and effort, not just in terms of providing the aviation services, but in having strong, intimate relationships with the people we serve.”

In the case of LIFESTAR, the partnership called for Med-Trans to provide and manage all aircraft and pilots associated with their program. Others, however, desire even more from the company, such as flight medics, management software, and patient billing.

A large portion of the company’s operation remains rooted in maintaining a total of 65 helicopters and one turboprop airplane for its 25 clients and their 55 bases.

“We are blessed to have a great relationship [with LIFESTAR] all built around being a regional asset to serve the 21 contiguous counties that are around the University of Tennessee Medical Center,” said Buttrell. “We both believe in safety in all of our endeavors, great care in people’s critical time of need, and great relationships in the markets that we take care of.”